Up to 40% of chronic low-back pain cases could caused by bacterial infections, and antibiotics could play a role treatment, new research suggests.
A new study found that antibiotic use led to significant improvements in 80% of patients with herniated disc and spinal swelling. However researchers cautioned that antibiotics should not be used “without due consideration.” Since low back pain is so common, prescribing antibiotics indiscriminately could be hazardous, they observed.
The researchers first found clues that infection could be linked to this specific type of low-back pain when they conducted a study of 61 patients with lumbar disc herniation undergoing spinal surgery. They took tissue bioposies of the affected discs and tested them for signs of bacterial infections. Forty three percent of patients had anaerobic bacteria present in their spinal discs, and 80% of those patients developed spinal swelling, also known as Modic type 1 changes. The researchers believe this could constitute a new disease category called Modic-related lower back pain.
To test the effects of antibiotics on these patients, the researchers conducted a second study, this time asking half of the patients to take antibiotics three times a day for 100 days. Compared to patients taking placebo pills, the ones using antibiotics had significantly better improvements in pain and disability at both the 100-day and one year follow-up.
Despite these results, the authors cautioned their findings specifically apply to the 35-40% of patients with chronic low-back pain who have Modic type 1 changes. Even still, confirming whether or not a patient is suffering from bacterial-related back pain would be challenging. In accompanying editorial, the researchers observed that it would be “ethically impossible” to take biopsy samples from all these patients since it can only be done in those undergoing surgery.
And prescribing antibiotics indiscriminately could come with certain risks, like gastrointestinal side effects, an increased risk of adverse events, and antibiotic resistance. “We do not support the proposition that all patients with lumbar pain should have a trail course of antibiotics,” they wrote.
Albert HB, et al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema ( Modic type 1 changes): a doubled-blind randomized clincal controlled trial of efficacy. European Spine Journal 2013; 22(4): 697-707.
Albert HB, et al. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? European Spine Journal 2013; 22(4): 690-696.